Splenic Tuberculosis - A Rare Case Report

Abstract

Splenic tuberculosis (splenic TB) is extremely rare. It is likely to be misdiagnosed as carcinoma of spleen, splenic abscess, lymphoma, or others. The misdiagnosis rate is high if there is no tuberculosis history in other organs. We came across a case of 27 years old immunocompetent female from good socioeconomic background who presented with weight loss and pain in left hypochondriac region. Ultrasonography of abdomen revealed multiple hypo echoic lesions in the spleen. MRI chest and abdomen revealed multiple splenic focal lesions with no contrast enhancement and well defined mass in the posterior mediastinum. Splenectomy was performed and sample was sent for histopathological examination and also microbiological analysis. Microscopic examination revealed splenic tissue with multiple variable sized granulomas showing epithelial cells, lymphocytes and Langhan’s giant cells, the larger one showed wide necrosis with nuclear debris and suppuration together with focal increase in plasma cells. This was consistent with the diagnosis of Mycobacterial infection with MRI finding of only mediastinal lymph node involvement in the lungs.